An internet-delivered Cognitive Behaviour Therapy for clinical perfectionism : a thesis presented in partial fulfilment of the requirements of the degree of Doctor of Clinical Psychology at Massey University, Albany, New Zealand
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Date
2019
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Massey University
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Abstract
Clinical perfectionism has been associated with a number of cognitive and
behavioural difficulties including work strain, procrastination, burnout, sleep disturbance,
and problems with rumination, intimacy, emotional expressiveness, and assertiveness. In
addition, it has been recognised as a vulnerability factor for the development and
maintenance of several psychological disorders, such as eating disorders, obsessive–
compulsive disorder, social anxiety, and depression. Cognitive behaviour therapy (CBT)
is a well-established treatment modality that has been demonstrated to be an effective
intervention for clinical perfectionism. Recently, advances have been made in terms of
the online delivery of effective CBT-based interventions. This study explored whether
an eight-week online, guided self-help treatment for elevated clinical perfectionism
produced clinically significant reductions in perfectionism, self-criticism, stress, low
mood and anxiety, and increases in self-esteem within an adult New Zealand sample.
The study included mixed methods, using a case series methodology with an AB
plus follow-up design. It included both a reliable and clinically significant change
(RCSC) analysis of repeated measures and a thematic analysis of module reflections and
interviews completed at follow-up. Twelve participants completed weekly measures of
perfectionism, mood, self-criticism and self-esteem over a four-week baseline phase and
eight-week intervention, and then completed follow-up measures and an interview two
months post-treatment. The intervention included eight weekly online self-help modules
of CBT for clinical perfectionism (CBT-P) guided by the lead researcher. Interviews were
completed individually with each participant to better understand how they experienced
the treatment under investigation and changes to their clinical perfectionism and related
difficulties.
This study explored the hypotheses that: 1) the treatment would produce clinically
significant reductions in clinical perfectionism, and 2) the treatment would also produce
clinically significant reductions in low mood, anxiety, stress and self-criticism, and
increases in self-esteem.
The study also sought to answer the question regarding how the participants
experience the guided ICBT-P.
RCSC was achieved in clinical perfectionism for 90% of the participants. For selfcriticism
and stress RCSC rates were 73% and 57%, respectively. Lower success rates
were observed in the final three phenomena, with RCSC occurring in 27% of participants
for self-esteem and 11% of participants for both depression and anxiety.
The analysis of qualitative data resulted in two major clusters of themes. The first
cluster described the participants’ experiences of the website and included four themes:
1) engagement with the treatment, 2) treatment delivery, 3) the website content, and 4)
the guiding therapy. The second cluster of themes, which covered the participants’
perceived outcomes of treatment, included six themes: 1) a change in thinking, 2)
developing insight, 3) an increase in self-love, 4) interpersonal improvements, 5)
improved productivity and 6) a work in progress.
This study provides initial evidence for the effectiveness of an eight-week online,
guided self-help treatment for clinical perfectionism within a New Zealand sample.
Participants perceived the treatment to be useful and reported experiencing a number of
promising outcomes.
Description
Listed in 2020 Dean's List of Exceptional Theses
Keywords
Perfectionism (Personality trait), New Zealand, Personality disorders, Treatment, Cognitive therapy, Internet in psychotherapy, Dean's List of Exceptional Theses